A statistic haunts me as I search for a new care home in preparation for mum’s final move. On average, residents of care homes get only two minutes of social interaction with staff a day.

While this statistic is based on a small sample of homes in England, I fear it sums up the quality of care in the UK. The randomised control study found that increasing interaction to 10 minutes a day improved residents’ wellbeing. Of course, 10 is better than two, but is 10 minutes enough?

Low expectations for vulnerable people

I welcome the study, and the associated programme, with its unique focus on improving wellbeing. But I wonder if it reflects the low expectations we have for some of the most vulnerable people in our society. According to Alzheimer’s Society, seven in 10 people living in care homes have dementia. They will normally be in the moderate to advanced stages of the disease, and their physical and emotional needs may be complex. They deserve better than this.

No option but to bring mum home

If left to her own devices, my mum soon becomes agitated or despondent. She wants to get home to see her parents or fears she has some responsibility beyond her abilities. If not supported appropriately her distress escalates to full blown meltdowns, as often happened in her previous care home.

The staff at mum’s home were kind and attentive, but they didn’t have adequate training in dementia care or any training in mental health issues. They were at a loss to help my mother.

After two and half years at the home, mum still didn’t settle. She often wished she was dead. So, after much personal anguish, I eventually decided to bring her home for a year. Apart from caring for her at home, I am using this time to develop a more effective care plan and find a better care home.

How to find the elusive good home

So how do you find a good home? Mum’s previous home was highly regarded, and I was initially very impressed. The setting, grounds and facilities were excellent. Most of the other families seemed entirely satisfied with the care provided. On top of this the quality of care had the thumbs up from the inspectors, Care Inspectorate Wales. In their last report they found, “people receive appropriate person-centred care to meet their individual physical and emotional needs”.

So, how do I look past outward appearances and positive reports to make the right choice this time? I have previously concluded the key is adequate training of staff and the quality of their interactions with residents. I still think that’s correct. But these critical elements depend on leadership. Management and policies determine how a care home recruits, trains, supports, manages and motivates their staff. If the home gets these things right, they are probably ticking other important boxes too. So now, I think the most critical question is ‘Does the care home have effective leadership?’

Does the care home have good leadership?

How do we find out? Helpfully, Care Inspectorate Wales and the inspectors for England, Scotland and Northern Ireland assess and report on ‘leadership’. That’s a start. The next thing is to meet with the home manager or senior carer and ask probing questions about staff recruitment, training and retention. See my suggested questions (PDF). You can find out a lot about management and the quality of care, by the responses to these questions. It’s also important to meet staff and see how motivated and engaged they are.

What specific dementia-care training do staff get?

Here, the Abertawe Bro Morgannwg Health University Board offers five days of comprehensive dementia-care training. It is informed by leaders in the field of dementia-care, people like Teepa Snow and her Postive Approach to Care. They offer the training free to all care homes in the area. Mum’s former care home preferred their own in-house training, which I believed was woefully inadequate. I raised the issue with the Head Office, but to no avail.

If a care home that I shortlist doesn’t take up the training offered by the health board, I will want very specific details on what they provide. It’s staggering that there are no minimum requirements for dementia-care training. The study, mentioned above, also found that, “out of 170 available training programmes for nursing home staff, only three are evidence-based – none of which improve quality of life.

Observing interactions with residents

Apart from examining the inspector’s report and interviewing the manager and staff, I will sit in the care home lounge to witness first-hand the quality and quantity of interactions with residents.

All this may sound onerous, but getting the decision wrong costs a lot more than time and energy. It repeatedly broke my heart to see and hear about the distress and anguish my mother faced.

Advice guides on finding a good care home

13 thoughts on “Desperately Seeking a Good Care Home

  1. It is the most distressing situation isn’t it. The fact that there is never a chance of improvement and that things can only get worse is heartbreaking and stressful.
    Your willingness to share your experience is probably helpful to lots of people, it certainly is to me, thank you and lots of luck with finding the right place. xxx


    1. Oh dear Sally, I don’t know how I missed your kind and encouraging response. It really is the responses that make the whole process of writing posts worthwhile and the act of caring less isolating. So I feel bad to not have seen this or responded. I think I need to change the setting so that comments are automatically published. It sounds like you are dealing with similar issues in your life and I’m so glad that the post was useful to you. Hope all is well. xxx

      Liked by 1 person

      1. I’m glad you found it encouraging but no need to apologise, I totally understand how things get missed. I find that I often miss things, even birthdays! My blog reading has become very patchy. I think going through the stress of our mum’s having this awful disease takes it’s toll. I meant what I said, I think it’s brave of you to write about it, I find it difficult, even to talk about, especially with people who don’t really understand.
        I hope things are going well. xxx

        Liked by 1 person

  2. This is an excellent account of a painful process for you, and a careful reflection on what you have learned. I’m sure it will be helpful for many others. Thank you for sharing these very personal experiences and reflections.
    One thought: occasionally, even with great leadership, an individual carer may just not ‘click’ with a resident. It’s not always possible (given pressure on staff) to find an alternative.
    The whole thing is, as you suggest, a very tricky calculus!


    1. I don’t know how I missed this lovely thoughtful comment which is obviously based on knowledge of the care home sector. Yes, that very same example has happened with my mum. Great management and staff at a care home mum has been in on respite, but mum really doesn’t get on with one member of staff who makes her feel uncomfortable. This home was on my top three, but following feedback from mum’s friend I have had to let this one go. Of course this could happen anywhere.

      Apologies for overlooking this comment.


      1. No need at all to apologize – the beauty of a blog is that communication doesn’t have to be synchronous! It has been my experience both as a hospital doctor (observing interactions between health care staff & patients), and as a relative of a care home resident. It is also a simple human fact – none of us likes everybody else; inter-personal chemistry is unpredictable, and at best, magic! You just dont know until you try…!


      2. No need at all to apologize – the beauty of a blog is that communication doesn’t have to be synchronous! It has been my experience both as a hospital doctor (observing interactions between health care staff & patients), and as a relative of a care home resident. It is also a simple human fact – none of us likes everybody else; inter-personal chemistry is unpredictable, and at best, magic! You just cannot know until you try…!

        Liked by 2 people

  3. Problem is, greedy care providers under staff on purpose to keep the wages low meaning vulnerable people don’t get the support they desperately need. Staff are spread so thinly, work insane hrs and put up with some pretty dodgy practices, it’s upsetting for staff and demeaning to the person receiving care and support.


  4. Hey Julia! I couldn’t feel for you both more. I worked in the NHS for 6 years and one thing they lack is the funds for the elderly especially dementia care. There is an ofsted of the medical world called Care Quality Comission inspecting medical facilities and care homes. It would often frighten me, reading the reports of such care homes and some either being closed or putting into special measures. I can’t generalise all care facilities but I’d encounter a lot of carers getting frustrated and not doing the job compassionately. When, at the end of the day caregiving is a compassionate job and you need to be open minded. Not do things regimentally or by the book!

    I’m sorry my comments are so negative, but I really hope you find your mum a suitable home. As this is one thing as a Brit I’m ashamed of which the UK lacks for the older generation.


    1. Thank you so much for reading my post Alex, and for your heartfelt and genuine concern. It’s not good enough is it? I’m really encouraged by initiatives like Dementia Care Matters, where the emphasis is on people’s feelings. My mum would get on very well in a place like that. Also I am aware of some really good homes, that are always striving to improve, keeping abreast of developments in dementia care and are open to learning from others. There is hope.

      Liked by 1 person

  5. Hi! Great article. I wish you luck in your search for the idea care home. You are doing all the right things. GM stayed with me for 2 years and then I moved her. When I searched for personal care homes, I took her with me! I watched her response to everyone. The one I picked, she went in the room with her potential roomie. The spent time alone together. They came out arm in arm asking could Grandma come back to visit. 🤗


    1. That is really lovely, Tiffany. If mum knew she was going to stay somewhere she would be anxious. I know this from previous experience, but we can go and sit in the communal areas of the shortlisted homes and I can observe which one she seems to be most at ease in. I plan to sit and observe anyway, might as well have mum with me. Thanks for the idea.


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